Mountain Lake Wellness LLC

Primary specialty

AcupuncturistTaxonomy code 171100000X

License

AC153196 Issued in OR

Legal business name

MOUNTAIN LAKE WELLNESS LLC

Practice address

2442 SE 101St Ave
Suite 308
Portland, OR 97216-3060

Phone

(503) 828-3050

NPI assigned

Jul 13, 2012

Last updated

Jul 13, 2012By the provider in NPPES

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Ms. Leslie Huddart, L.AC.

Title

Owner

Phone

(503) 828-3050

Specialties & licenses 1

Addresses

Locations

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Sarah Reid, LAC

  • Acupuncturist
  • Walla Walla, WA
  • NPI 1326405705
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1342137600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1342137600000",
    "number": "1841545092",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2442 SE 101ST AVE",
            "address_2": "SUITE 308",
            "city": "PORTLAND",
            "state": "OR",
            "postal_code": "972163060",
            "telephone_number": "503-828-3050"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2442 SE 101ST AVE",
            "address_2": "SUITE 308",
            "city": "PORTLAND",
            "state": "OR",
            "postal_code": "972163060",
            "telephone_number": "503-828-3050"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MOUNTAIN LAKE WELLNESS LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2012-07-13",
        "last_updated": "2012-07-13",
        "status": "A",
        "authorized_official_last_name": "HUDDART",
        "authorized_official_first_name": "LESLIE",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "503-828-3050",
        "authorized_official_name_prefix": "Ms.",
        "authorized_official_credential": "L.AC."
    },
    "taxonomies": [
        {
            "code": "171100000X",
            "taxonomy_group": "",
            "desc": "Acupuncturist",
            "state": "OR",
            "license": "AC153196",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Zoe Xin Moulton
• Madeleine Claire Leigh Moum
• Christine Moung-Wen, M.D.
• Eddie Mark Mounivong, MSW
• Mount Tabor Physical Therapy LLC (Mount Tabor Pelvic Therapy)
• Mountain Park Chiropractic PC (Robert D Bach)
• Mountain Park Health Clinic
• Mountain Spring Health Clinic, LLC
• Mountain View Rehabilitation and Healthcare Center, LLC
• Mountainside Family Dentistry LLC

• Acupuncturist in Portland, OR
• Providers in Portland, OR by specialty
• Acupuncturist in Oregon

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 13, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.